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Myasthenia Gravis and Vaccines

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By Editorial Team

Last Updated:

3 min read

Getting vaccines is very important for all people, but it is especially important for people with myasthenia gravis (MG). Some treatments for MG can weaken the immune system. This means infections can cause serious problems. These infections may be less harmful to people with healthy immune systems.1,2

General vaccine recommendations for people with MG

Most non-live vaccines are safe for people with MG. This is true even for those taking medicines that weaken the immune system. Recommended vaccines include:1,2,4

  • Influenza (flu) – The flu shot is strongly recommended every year. It helps prevent the seasonal flu. The flu can make MG symptoms worse.
  • Pneumococcal – These shots help protect against a serious lung infection called pneumonia.
  • Tetanus, diphtheria, pertussis (Tdap) – People need this shot at certain ages. They also need a booster shot every 10 years.
  • Hepatitis B – This vaccine is recommended for people who are at risk.
  • Human papillomavirus (HPV) – This vaccine is recommended for certain age groups.
  • Inactivated polio – This is the polio shot. It is usually given in childhood, but adults can get it if needed.
  • Non-live Shingles shot – This shot (recombinant zoster vaccine) is recommended for people 19 and older with weakened immune systems.
  • COVID-19 – It is very important to get the COVID-19 vaccine and boosters. These shots protect against severe illness. COVID-19 can be very dangerous for people with MG. Studies show these vaccines are generally safe for people with stable MG.

Why live vaccines need special attention

Live vaccines are usually not recommended for people taking strong medicines that weaken the immune system. This is because the vaccines contain a weak, live germ. They could cause an infection. Live vaccines include:2

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  • Nasal spray flu vaccine
  • One type of shingles vaccine (live zoster vaccine)
  • Measles, mumps, rubella (MMR) vaccine
  • Varicella (chickenpox) vaccine
  • Yellow fever vaccine

Review your list of medicines and immune health with your doctor before getting any live vaccine.

Meningococcal vaccines and specific MG treatments

Special care is needed for meningococcal vaccines. This applies to people with MG who use or plan to use "complement inhibitors." An example is ravulizumab (Ultomiris®).1-3

These medicines work by slowing down a part of the immune system. This part is called the "complement system." This system helps fight the germs that cause serious meningococcal infections. Taking these medicines increases the risk of these serious infections.1-3

Recommendations if you take complement inhibitors

The Centers for Disease Control and Prevention (CDC) has recommendations for people taking complement inhibitors. They recommend getting 2 different types of meningococcal vaccines. These are the MenACWY and MenB vaccines:1,3

  • MenACWY – This vaccine protects against 4 types (A, C, W, and Y) of the germ. The first set of shots is usually 2 doses. The doses are given at least 8 weeks apart. You will need a booster shot every 5 years for as long as you take the medicine.
  • MenB – This vaccine protects against type B of the germ. There are 2 brands (Bexsero and Trumenba). You cannot switch between the 2 brands. They have different shot schedules.
  • Bexsero – The first set is 2 doses, given at least 1 month apart. A booster is given 1 year later. Boosters are then needed every 2 to 3 years if the risk continues.
  • Trumenba – The first set is 3 doses. The shots are given at 0, 1 to 2, and 6 months. A booster is given 1 year later. Boosters are then needed every 2 to 3 years if the risk continues.

Timing, warnings, and other things to know

It is best to get all meningococcal vaccine shots at least 2 weeks before you start taking a complement inhibitor.1,3

Sometimes, you need to start the medicine right away and are not up to date on these vaccines. If this happens, your doctor may give you antibiotics to help prevent infection. You should get the vaccines as soon as possible.3

Your doctor should make sure you and your caregivers understand the high risk of meningococcal disease. You must know the symptoms. It is very important to get medical help right away if symptoms appear. This is true even if you got the vaccine.3

The vaccine does not remove all risk of meningococcal disease for people on these medicines. Doctors will watch closely for any signs of infection. This is true even if you got the shots or are taking antibiotics.1,3

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Myasthenia-Gravis.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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